Phillips Edward H, Toouli James, Pitt Henry A, Soper Nathaniel J
Department of Surgery, Cedars-Sinai Medical Center, 8635 W. Third St., Suite 795W, Los Angeles, CA 90048, USA.
J Gastrointest Surg. 2008 Apr;12(4):624-8. doi: 10.1007/s11605-007-0452-0. Epub 2008 Jan 5.
Several techniques of laparoscopic bile duct exploration and intraoperative endoscopic sphincterotomy (ES) have been developed to treat patients with common bile duct (CBD) stones in one session and avoid the complications of ES. With all these options available, very few randomized controlled trials (RCTs) have been undertaken. This review analyzes those studies.
We searched PubMed. Four RCTs and a Cochran Database Systematic Review were found.
Two RCTs compared preoperative ES and laparoscopic CBD exploration (E) for known CBD stones. Laparoscopic CBDE had shorter length of hospitalization. Two RCTs compared immediate and delayed treatment and found that length of stay was less with laparoscopic CBDE, but clearance rates and morbidity/mortality were similar.
Studies suggest that CBD stones discovered at the time of cholecystectomy are best treated during the same operation. The transcystic approach is safest if applicable. Individual surgeons must be aware of their own capabilities and those of the available endoscopists and perform the safest technique.
为了一次性治疗胆总管（CBD）结石患者并避免内镜括约肌切开术（ES）的并发症，已经开发了几种腹腔镜胆管探查和术中内镜括约肌切开术（ES）技术。有了所有这些选择，进行的随机对照试验（RCT）却很少。本综述分析了这些研究。
我们检索了PubMed。发现了四项随机对照试验和一篇Cochrane系统评价数据库文章。
两项随机对照试验比较了术前内镜括约肌切开术（ES）和腹腔镜胆总管探查术（E）治疗已知胆总管结石的效果。腹腔镜胆总管探查术（CBDE）的住院时间较短。两项随机对照试验比较了即时治疗和延迟治疗，发现腹腔镜胆总管探查术（CBDE）的住院时间较短，但结石清除率和发病率/死亡率相似。
研究表明，胆囊切除术中发现的胆总管结石最好在同一次手术中治疗。如果适用，经胆囊途径是最安全的。个体外科医生必须了解自己的能力以及现有的内镜医生的能力，并采用最安全的技术。
